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Introduction: When monotherapy used alone or sequentially fails to achieve seizure control, a trial of combination therapy may be considered., Objective: To define optimal criteria to guide choice of an antiseizure medication (ASM) for use as first add-on., Methods: A standardized Delphi procedure was applied to produce a list of consensus statements. First, an Expert Board consisting of 5 epileptologists agreed on a set of 46 statements relevant to the objective. The statements were then finalized through an iterative process by a Delphi Panel of 84 Italian pediatric and adult neurologists with expertise in the management of epilepsy. Panel members provided anonymous ratings of their level of agreement with each statement on a 9-point Likert scale., Results: Consensus, defined as agreement by at least 80% of Panel members, was reached for 36 statements. Medication-related factors considered to be important for drug selection included efficacy, tolerability and safety, interaction potential, mechanism of action, and ease of use. The need to optimize adherence and to tailor drug selection to individual characteristics was emphasized., Conclusions: Choice of an ASM for first add-on requires consideration of many factors, many of which also apply to choose initial treatment. Factors more specifically relevant to add-on use include drug interaction potential and the preference for an ASM with a different mechanism of action., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Antonio Gambardella received speaker’s or consultancy fees from Eisai, UCB Pharma and Zogenix. Paolo Tinuper received speaker’s or consultancy fees from Arvelle, Eisai, GW Pharma, LivaNova, UCB Pharma, Xenon Pharma and Zogenix. Benedetto Acone received speaker’s or consultancy fees for projects sponsored by Eisai, Astra Zeneca, Novartis, Gilead, Abbvie, Sanofi, Sandoz, Sobi, MSD, Angelini, AlfaSigma, Janssen, Kyowa Kirin, Abiogen, Amgen, Teva; Giangennaro Coppola received speaker’s or consultant fees from Eisai and Humana; Paolo Bonanni received speaker’s or consultancy fees from Eisai, LivaNova, Lusofarmaco and Proveca; Emiio Perucca received speaker’s or consultancy fees from Arvelle, Biogen, Corlieve, Eisai, GW Pharma, Sanofi, Sun Pharma, UCB Pharma, Xenon Pharma and Zogenix., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Since the publication of the Italian League Against Epilepsy guidelines for the treatment of status epilepticus in 2006, advances in the field have ushered in improvements in the therapeutic arsenal. The present position paper provides neurologists, epileptologists, neurointensive care specialists, and emergency physicians with updated recommendations for the treatment of adult patients with status epilepticus. The aim is to standardize treatment recommendations in the care of this patient population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: There has been a rapid expansion in the number of research papers published on clinical epilepsy topics and the number of journals in the medical field. In this expanding publishing environment, the question arises as to how much of the published medical literature has 'enduring value' in terms of advancing knowledge in any significant way., Methods: We developed a methodology to assess the enduring value of papers published in the field of clinical epilepsy and established its internal validity. We studied 300 research papers published in 1981, 1991, and 2001 (100 in each year) and assessed their enduring value in four domains: citations in the last year, citations in the last 10years, citations in the standard epilepsy textbook, and a subjective assessment by an experienced epileptologist., Results: Of the 300 papers, 214 (71%) were categorized as having 'no enduring value', and only 11 (4%) were identified as having 'high enduring value'. The 'high enduring value' papers could generally be identified immediately on publication, by high initial citation values, and were also more likely to be published in journals with a high impact factor. The commonest characteristics of a paper with no enduring value were that they reported research that was inherently unimportant (55.6%), not novel (38.8%), or had significant methodological flaws (22.0%)., Conclusions: Although there are other reasons for publishing papers, the fact that the great majority of published papers lack enduring value in terms of advancing knowledge should be a concern to the medical and scientific community., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: At least 30% of youth with epilepsy will require transition from pediatric to adult neurology care. Many adolescents and young adults (AYAs) with epilepsy are inadequately prepared for health care transition, which may contribute to health care disruptions and decreased quality of life. The current study aimed to add to the growing body of literature on health care transition in epilepsy by characterizing a sample of AYAs with epilepsy and assessing the relationship between pre-existing and behaviorally modifiable factors and epilepsy-specific transition readiness., Methods: 103 AYAs (M age  = 17.56; range = 14-21; 54% female; 85% White) with epilepsy and 84 of their caregivers were enrolled from two pediatric hospitals in the United States. Participants provided sociodemographic and medical information and completed questionnaires assessing functioning, epilepsy management, and transition readiness. Data were analyzed using a two-step hierarchical multiple linear regression model with epilepsy-specific transition readiness as the outcome: 1) pre-existing factors (i.e., age, insurance, seizure severity); and 2) behaviorally modifiable factors (i.e., cognitive functioning, medication self-management, epilepsy self-efficacy)., Results: Only 44% of AYAs had discussed health care transition with their pediatric neurologist. The final model was significant, ΔF (3, 90) = 13.45, p < 0.001. Older age and greater epilepsy self-efficacy were associated with greater epilepsy-specific transition readiness., Conclusion: AYAs with greater epilepsy self-efficacy may be better prepared for the transition from pediatric to adult neurology care. Routine assessment of epilepsy self-efficacy and transition readiness starting in early adolescence may help to identify individuals who could benefit from targeted interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Drug-resistant epilepsy usually requires the use of polytherapy with antiseizure medications (ASMs) for management, which could involve side and adverse effects that may impact quality of life (QOL). This systematic review summarizes the evidence about the relationship between ASM polytherapy and QOL in epilepsy patients, considering clinical, sociodemographic, and psychological variables., Method: This review followed the PRISMA guidelines and was registered in PROSPERO. The studies examined were collected from PubMed/MEDLINE, Scopus, Web of Science, and Embase. The data extracted were categorized into three categories: therelationship between the number of ASMs and QOL, differences in QOL between patients taking polytherapy and patients taking monotherapy, and therole of other variables on QOL., Results: The review included 34 studies. Thirty examined the relationship between the number of ASMs and QOL, 93.3% of them identifying a significant association between a higher number of ASMs and poorer QOL. Fifteen studies analyzed differences in QOL between patients receiving polytherapy and those on monotherapy, all of them showing poorer QOL in those on polytherapy. Thirty-two studies considered other factors beyond polytherapy as determinants of QOL, including clinical, sociodemographic, and psychological variables, and higher seizure frequency and mood comorbidities (depression and anxiety) emerged as the strongest predictors of poor QOL., Conclusions: Polytherapy, despite being necessary for managing drug-resistant epilepsy, significantly contributes to impairing QOL. Effective seizure control remains critical, but a multifactorial approach addressing mental health and social determinants is essential for improving QOL in epilepsy patients. Future research should focus on optimizing treatment strategies that balance seizure control by minimizing the negative impact of polytherapy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Cerebral infections are a common cause of structural focal epilepsy, particularly in developing countries, where the risk of unprovoked seizures is higher and is related to brain lesions and status epilepticus during the acute phase. Despite the prevalence of pharmacoresistant epilepsy after cerebral infections, few patients are referred for epilepsy surgery. However, those with mesial temporal sclerosis (MTS), particularly linked to meningitis or encephalitis in early life, are excellent surgical candidates. Encephalitis before age four is associated with MTS, indicating a period of hippocampal vulnerability. Temporal resections are the most common procedures in these patients. In contrast, extratemporal resections are less common and generally less successful, especially in patients with multifocal epilepsy or parasitic infections. Patients with severe hemispheric damage from infections and contralateral hemiparesis may undergo hemispheric procedures, with overall favorable outcomes. Surgery for post-viral encephalitis, such as herpes simplex virus encephalitis, is often less effective due to widespread brain involvement, though younger patients with unilateral hippocampal atrophy fare better. Although neurocysticercosis is a leading cause of epilepsy in endemic regions, surgery is rarely performed. However, resecting MTS along with calcified lesions can improve seizure control in pharmacoresistant cases. This review emphasizes the importance of surgery for appropriately selected patients with postinfectious epilepsy., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Georgia Ramantani reports financial support was provided by Swiss National Science Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Individuals with epilepsy are at greater risk for tobacco use, which may exacerbate their health challenges. This study examines the prevalence and sociodemographic correlates of electronic nicotine delivery systems (ENDS), cigarette, and dual use among US adults with and without epilepsy., Methods: Data from the 2021-2023 National Health Interview Surveys were analyzed (N = 86,655 adults aged ≥ 18 years), including 1,579 (1.89 %, estimated 14.5 million US adults) with self-reported epilepsy (outcome variable). Participants were categorized into mutually exclusive groups: never-use of either product [reference group], current (used on some days or daily) cigarette-only use, ENDS-only, dual-use, former cigarette-only, former ENDS-only, and former dual-use. Weighted logistic regression models assessed the relationship between epilepsy and tobacco use, adjusting for sociodemographic characteristics., Results: Adults with epilepsy had higher rates of cigarette-only (16.51 % vs. 9.27 %), ENDS-only (5.56 % vs. 3.95 %), and dual use (3.53 % vs. 1.50 %) compared to those without epilepsy. Relative to never use, current cigarette-only use (AOR = 1.66, 95 %CI: 1.36-2.01), current ENDS-only use (AOR = 1.51, 95 %CI: 1.08-2.13), and current dual use (AOR = 2.29, 95 % CI: 1.56-3.48) were associated with higher odds of epilepsy after adjusting for demographic and health factors. Among adults with epilepsy, identifying as gay, lesbian, or bisexual was linked to higher odds of cigarette, ENDS, or dual use compared to straight individuals. Lower levels of education were associated with higher odds of cigarette smoking, while having health insurance was associated with lower odds among adults with epilepsy. Adults ≥ 35 were more likely to smoke cigarettes and less likely to use ENDS compared to younger age groups., Conclusion: Cigarette, ENDS, and dual use rates were higher in adults with epilepsy than in those without epilepsy. Social factors like sexual orientation, education, and insurance status further influence tobacco use within this population. Tailored cessation interventions are warranted for this vulnerable population to reduce disease burden., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

This survey evaluated the Brazilian population's physical exercise habits and compared them with those from two decades ago. In this cross-sectional study, 432 people with epilepsy (PWE) assessed the questionnaire. Of these, 387 (age: 33 ± 10.58, 81.4 % women) completed the questionnaire. Among them, 60.5 % were involved in regular physical activities. Among those who exercise regularly, the majority (96.5 %) exercised between 2 and 5 times weekly and had been physically active for at least two years. Only 23.3 % were prohibited by their doctors from participating in physical activities. Only 10 % reported that seizures occur during exercise, and about half of them (55.8 %) believed that exercise improves or has no effect on seizure frequency. Most (79.06 %) did not or rarely believe exercise can trigger seizures. More than half (57.3 %) were not afraid to have seizures during exercise or were not afraid of injury during exercise due to a seizure (69 %). Most believed exercise improves cognition (80.9 %), depression, and anxiety (93.8 %). We visited this scenario two decades early. In our previous study, only 15 % exercised regularly, while in this survey, 58.4 % routinely exercised. Our findings also align with our initial survey, indicating a low seizure frequency during regular exercise, a belief that physical activity reduces seizure frequency, and a reduction in the fear that exercise might trigger seizures. In conclusion, our results show that after two decades, there have been several improvements in physical and sports activity participation among PWE. Implementing strategies to reduce barriers to exercise for PWE and educating them on the benefits of physical activity can help improve this scenario., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study aimed to investigate the impact of fatalism, self-management, and self-esteem on the quality of life of individuals with multiple sclerosis and epilepsy., Methods: A cross-sectional study was conducted between February and May 2024 with 122 MS patients and 108 epilepsy patients. Participants completed questionnaires measuring fatalistic beliefs, self-management, self-esteem, and quality of life. Data were collected through face-to-face interviews during hospital visits. Statistical analyses included t-tests, Mann-Whitney U tests, and hierarchical regression., Results: MS patients reported significantly higher levels of fatalism and lower levels of self-esteem compared to epilepsy patients. However, both groups reported statistically significant relationships between fatalism, self-management, self-esteem, and quality of life. Hierarchical regression analyses revealed that the factor of fatalism negatively impacted quality of life in both groups, while self-management and self-esteem were positively associated with quality of life. Although these variables consistently impacted the quality of life for both groups, the magnitude of these effects and the amount of variance explained differed., Conclusions: These findings highlight the importance of addressing fatalistic beliefs, promoting self-management skills, and enhancing self-esteem in both MS and epilepsy patients. Intervention programs focusing on these psychosocial factors could significantly improve the quality of life for individuals living with these chronic neurological conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Therapeutic goals in epilepsy treatment may be highly individual. The aim of the present study was to develop a questionnaire assessing patients' needs and benefits of epilepsy treatment, the Patient Benefit Index on Epilepsy (PBI-Epilepsy)., Methods: We recruited adult patients during their stay at a university based epilepsy centre. Patients completed a survey asking about their burden and treatment goals. Data were categorised using qualitative content analysis. The final category system was discussed in an expert panel. The questionnaire was pre-tested using cognitive debriefing and adapted until no changes were required anymore., Results: In the open survey, 25 people with epilepsy participated (60.0 % female, 33.2 years, 1-55 years epilepsy). The final category system included nine main categories (namely psyche, working life, seizures, therapy, leisure activities, social relationships, mobility, body, everyday life activities). From this, the expert panel developed a first draft of the PBI-Epilepsy. The questionnaire went through five rounds of cognitive debriefing with 29 patients (51.7 % female, 34.6 years, 2-37 years epilepsy). We decided to develop two versions of the questionnaire depending on the patient's treatment (medical or surgical). A bipolar response scale was used in the part asking about treatment benefits, as epilepsy treatment can lead to both improvement and deterioration. The final questionnaire consists of two parts (patient needs and treatment benefits) each encompassing 21 items., Conclusion: We aimed to reflect the wide range of issues that are relevant for people with epilepsy while developing a questionnaire that is short and easy for patients to understand., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: Based on the protection motivation theory (PMT), which is an extension of the health belief model that takes the "reward" brought by behavior in the long-term process as a consideration factor and considering the influence of environmental and social factors on behavior patterns, this cross-sectional study evaluated medication adherence among children with epilepsy using structural equation modeling., Methods: Children with epilepsy from pediatric neurology clinics were consecutively sampled at West China Second Hospital of Sichuan University from July 2021 to January 2024. According to PMT, we designed the 23-item questionnaire, which included seven factors, namely severity, susceptibility, external return, internal returns, self-efficacy, reaction efficiency, and reaction cost. Medication adherence was assessed using the Morisky Medication Adherence Scale. The reliability and validity of the scale were tested by confirmatory factor analysis, and path analysis was used to conduct hypothesis testing and calculate standardized path coefficients., Results: We enrolled 1357 children with epilepsy (mean age, 8.36 ± 4.04 years). Younger age, being an only child, caregivers' unemployment, and comorbidities were associated with high medication adherence scores. The designed scale of PMT displayed good reliability and validity. Through path analysis of the structural equation model, self-efficacy, susceptibility, and severity exerted significant positive effects on adherence, and external return, internal returns, and reaction cost had significant negative effects on adherence., Conclusions: Medication adherence in children with epilepsy is relatively poor. PMT can explain and predict the medication adherence behavior and behavior intention of patients with epilepsy. It is recommended to increase the health education, personalize medication guidance, and provide telephone interventions to caregivers of children with epilepsy to enhance medication adherence and further improve therapeutic efficacy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Traditional/alternative and complementary medicine (TCM) encompasses products, practices and practitioners that do not form part of conventional treatment and are not an integral part of the main health care systems. They are very common in the management of epilepsy and mental health conditions, particularly in low- and middle-income countries (LMIC). For instance, in a population-based survey in Africa, over 70% of people with epilepsy had visited a traditional health practitioner before the survey, with similarly high estimates reported in Asia and South America. Accessibility, cultural appropriateness/alignment, non-response to conventional (biomedical) medicine, and exercise of control over one's treatment were some of the reasons TCM was preferred over conventional medicine. There is also emerging evidence that TCM products administered alone or together with anti-seizure medications result in improvement in seizure control, psychiatric comorbidities, and quality of life. Most of the convincing evidence is from biological-based therapies for example, multivitamin supplementation, ketogenic diet and cannabidiol extracts. Mind-based therapies e.g. Yoga and whole-body systems therapies e.g. Ayurdelic and Traditional Chinese Medicine have also generated interest in epilepsy care. There is a paucity of effectiveness studies of these therapies in LMIC such as Africa, where capacity to take these products through clinical trials is limited. There are however serious concerns on reliability of reported findings because of inadequate randomization, and small sample sizes, and concerns on quality and safety owing to lack of standardization of bioactive compounds, accidental or intention botanical substitution of products and unhygienic handling. There is growing interest in TCM worldwide because of its economic potential, concerns on safety and quality and potential for integration into the health care systems. There is urgent need to develop and implement national TCM regulatory policies and programmes aimed at expanding the knowledge base and providing guidance on quality assurance standards. However, LMIC continue to lag in implementation of these policies and guidelines, especially in the areas of research and development and regulation of TCM practice. Working with stakeholders, countries are advised to assess their own national situations in relation to TCM, and then develop practical solutions to accommodate these approaches. For instance, conduct surveys on benefits and risks of TCM in the management of epilepsy in the local context and use this information to promote appreciation of a role for TCM, which will ease integration into the main health systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: One of the most significant challenges faced by people with epilepsy is the stigma imposed by the broader community. We aim to assess the dynamics of stigma and the level of misconceptions towards individuals with epilepsy by comparing two studies conducted decades apart., Methods: Awareness-raising campaigns and professional skill development activities were conducted. We utilised a Georgian-adapted structured questionnaire and the Stigma Scale of Epilepsy (SSE) questionnaire, which had previously been validated in Georgian. A cross-sectional study was conducted. We used multivariable logistic regression analysis to develop a predictive model for stigma perception. To compare the two studies, we used the Chi-squared test to examine differences in proportions between the two populations, including the 95% Confidence Interval (CI) for the difference in proportions. A p-value of less than 0.05 was considered statistically significant., Results: Of the 1,146 participants, 502 (43.8%) were female, and 207 (18.1%) had a medical education. Higher levels of stigma were observed more frequently among individuals without a medical background. Participants who perceived epilepsy as a psychiatric disorder, a hereditary condition, or a congenital disability exhibited higher levels of stigma. Comparisons between the two studies reveal a significant decrease in the number of individuals who would oppose their child marrying or playing with someone who has epilepsy., Conclusions: Respondents with medical backgrounds were less likely to express stigma and misconceptions. A comparison of the two studies indicates a statistically significant improvement over the past decade, likely to be partly attributable to regular awareness-raising campaigns., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study aimed to investigate the effect of a walking program based on the COM-B Behavior Change Model on self-management, anxiety, stress, depression, quality of life, and seizure frequency in individuals with epilepsy., Methods: A prospective, parallel-group controlled experimental design and mixed methods were used. A total of 78 individuals with epilepsy were included in the study and randomly assigned to the intervention (n = 38) and control (n = 40) groups. The intervention group participated in a weekly, twice-a-week, walking program for 12 weeks. The program was based on the COM-B model, focusing on increasing individuals' capability, opportunity, and motivation levels. The control group received standard treatment. Self-management, anxiety, stress, depression, and quality of life were measured using scales. Seizure frequency was measured using daily logs. Qualitative data was collected through semi-structured interviews with 10 participants to understand barriers to walking in individuals with epilepsy., Results: Qualitative data revealed time constraints, lack of motivation, and safety concerns as barriers to walking participation. After a 12-week intervention, a significant increase in self-management levels, a significant decrease in anxiety, stress, and depression levels, a significant improvement in quality of life, and a significant reduction in seizure frequency were observed in the intervention group. No significant changes were observed in these variables in the control group., Conclusion: This study demonstrated that a walking program based on the COM-B Behavior Change Model had a positive impact on self-management, mental health, and quality of life in individuals with epilepsy and may help reduce seizure frequency., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The electroencephalogram (EEG) exhibits characteristics of complexity and strong randomness. Existing deep learning models for EEG typically target specific objectives and datasets, with their scalability constrained by the size of the dataset, resulting in limited perceptual and generalization abilities. In order to obtain more intuitive, concise, and useful representations of brain activity, we constructed a reconstruction-based self-supervised learning model for EEG based on Variational Autoencoder (VAE) with separate frequency bands, termed variational auto-encoder for EEG (VAEEG). VAEEG achieved outstanding reconstruction performance. Furthermore, we validated the efficacy of the latent representations in three clinical tasks concerning pediatric brain development, epileptic seizure, and sleep stage classification. We discovered that certain latent features: 1) correlate with adolescent brain developmental changes; 2) exhibit significant distinctions in the distribution between epileptic seizures and background activity; 3) show significant variations across different sleep cycles. In corresponding downstream fitting or classification tasks, models constructed based on the representations extracted by VAEEG demonstrated superior performance. Our model can extract effective features from complex EEG signals, serving as an early feature extractor for downstream classification tasks. This reduces the amount of data required for downstream tasks, simplifies the complexity of downstream models, and streamlines the training process., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Stress is one of the most common trigger factors for epileptic seizures and is strongly related to clinical and emotional variables. Despite its influence in the course of the disease, there is an absence of instruments for measuring perceived stress in people with drug-resistant epilepsy. Therefore, this study develops and validates the Epilepsy Perceived Stress Inventory for Adults (EPSI-A), a self-report inventory in Spanish designed to quantify perceived chronic stress in this population., Method: The sample consisted of 236 patients with drug-resistant epilepsy who underwent a neuropsychological assessment in which anxiety, depression, and quality of life were explored. In addition, from 125 patients in the sample, 9 measures of salivary cortisol were collected during the evaluation., Results: The EPSI-A consisted of 15 items, with higher scores indicating higher perceived stress. The exploratory factor analysis showed a four-factor solution: epilepsy concerns (5 items); impact on daily performance (4 items); social consequences (3 items); and epilepsy severity (3 items). These factors explained 63.3 % of the total variance. Internal consistency reliability measured with McDonald's omega and Cronbach's alpha coefficients was satisfactory, with values ≥ 0.78 (except for epilepsy severity with values of 0.59 and 0.58, respectively). Construct validity was demonstrated by its correlation with several psychological scales and clinical variables., Conclusions: The results showed that the EPSI-A is a reliable and valid tool for assessing perceived chronic stress in people with epilepsy. Its conciseness, rapid administration time, and specificity make it an appropriate instrument for this population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Observational studies suggest that hypertension and epilepsy have a high co-occurrence, and antihypertensive medications may have impacts on the prevention and treatment of epilepsy. However, the directionality of causation between them is elusive., Method: By leveraging genome-wide association studies (GWAS) summary data of each trait, we firstly performed bidirectional univariate Mendelian randomization (UVMR) to assess the strength and direction of the associations between pairs of traits, then multivariate MR (MVMR) was conducted to adjust for potential confounders in causalities. Cochran's Q statistics, leave-one-out analysis, MR-Egger regression and MR-Pleiotropy Residual Sum and Outlier methods (MR-PRESSO) were employed to evaluate the robustness of the results. Drug target MR was proceeded to assess the association between five classes of first-line antihypertensive medications and epilepsy. Specifically, single nucleotide polymorphisms (SNPs) extracted from GWAS data on systolic blood pressure (SBP)/diastolic blood pressure (DBP), along with expression quantitative trait loci (eQTL) were utilized as proxies for antihypertensive medications, respectively., Results: Forward UVMR results provided evidence that genetically predicted blood pressure traits and hypertension have causal effects on epilepsy, while reverse UVMR indicated no causal impacts of epilepsy on blood pressure traits or hypertension. The sensitivity analysis results were robust. The causalities between DBP, hypertension and epilepsy remained remarkable after adjustment by MVMR. Inverse-variance-weighted MR (IVW-MR) yielded evidence of positive association only between Beta-Blockers target genes based on DBP GWAS screening and epilepsy. Summary-data-based MR (SMR) identified a positive correlation between Beta-Blockers target gene ADRA1D and epilepsy risk., Conclusions: Hypertension has a causal effect on epilepsy and managing DBP in patients with hypertension through Beta-Blockers may help prevent epilepsy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Understanding parental attitudes and health literacy is crucial for promoting safe and effective medication use, which is pivotal in managing epilepsy, a condition requiring consistent and informed treatment decisions. So, this study aimed to determine the impact of health literacy among parents of children with epilepsy on their attitudes towards rational drug use., Method: This study, conducted at a university hospital's Child Neurology Outpatient Clinic in Konya, Turkey from May to December 2023, employed a descriptive research design involving 234 parents of children with epilepsy who attended routine check-ups during this period. Data collection utilized a Demographic Information Form, the Parental Attitude Scale towards Rational Drug Use, and the Health Literacy Scale, analyzed using IBM SPSS Statistics Standard Concurrent User V 25. Analytical methods included descriptive statistics (number, percentage, mean, standard deviation, median, minimum, maximum), as well as One-Way ANOVA, Independent-Sample T Test, Correlation, and Linear Regression (Enter method), with statistical significance set at p < 0.05., Results: It was determined that 67.1 % of the parents participating in the study were female, with a mean age of 35.85 ± 0.47 years, and the average age of the children was 7.93 ± 4.78 years. It was found that 66.7 % consult a doctor first about the medications they use and health concerns, 97 % do not use medication for their children without a doctor's prescription, and of those who do use non-prescription medication, 32.9 % administer antipyretics. The average total score of the Health Literacy Scale was moderate (43.17 ± 10.99), and the average total score of the Parental Attitude Scale towards Rational Drug Use was high (164.09 ± 32.09). Parental education level, occupation, and income status variables showed statistically significant differences in health literacy and attitudes towards rational drug use. Additionally, a moderately significant positive correlation was found between parents' health literacy and their attitudes towards rational drug use., Conclusion: This study underscores the critical influence of health literacy on parental attitudes towards rational drug use in children with epilepsy, emphasizing responsible healthcare decision-making. It advocates for tailored interventions to enhance health literacy among parents, aiming to foster safer medication practices and improved health outcomes for children with epilepsy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study aimed to clarify perceptions of the transition from pediatric to adult care for patients with childhood-onset epilepsy in Japan., Methods: A qualitative descriptive study design was used. Semi-structured interviews were conducted with patients with childhood-onset epilepsy who had transitioned to adult care attending a tertiary hospital's adult outpatient care unit specializing in treating epilepsy. Data were analyzed using content analysis to extract perceptions regarding the transition from pediatric to adult care., Result: Six male and seven female patients between the ages of 18 and 49 years participated in the study. Seventeen perception categories regarding the experience of transitioning from pediatric to adult care were identified: {I followed a specific transfer process}, {I want to transition to adult care}, {I want to remain in pediatrics},{I have noticed something after transitioning to adult care}, {I recall trust in pediatricians}, {increased motivation for self-management}, and {I want detailed explanations about illness}., Conclusions: The patients wanted to transition to adult medicine, but were passive, waiting for their physicians to suggest the transition. Furthermore, their perceptions of their own self-care varied. Pediatric healthcare providers should discuss and support the decision to transition from pediatric to adult care and provide information to help patients with childhood-onset epilepsy accept their future and understand their self-management requirements. These patients may become independent through the transition to adult care, and collaboration between pediatric and adult medicine is important to pass the responsibility of self-support to medical providers in adult care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

As the adequacy of determining hemispheric language lateralization (HLL) is of special importance for the planning of epilepsy surgery, this study aimed to identify predictive factors for receiving inconclusive HLL results using functional transcranial Doppler sonography (fTCD). Data from 495 epilepsy patients who received fTCD in a standardized fashion was analyzed retrospectively. HLL was left-sided in 324 patients (65.5 %), right-sided in 76 (15.4 %), and inconclusive in 95 (19.2 %). Univariate logistic regression analyses revealed significant positive associations between inconclusive HLL results and a multiregional localization of epilepsy. Significant negative associations with higher educational qualification, more years of education, and better letter verbal fluency were found. In multiple logistic regression analyses, a multiregional localization of epilepsy (OR = 2.74, p < 0.001) and years of education (OR = 0.86, p < 0.001) remained independent predictors. A cut-off value of 10.77 years of education determined by discriminant function analyses is provided. Our findings indicate that the adequacy of determining HLL using fTCD is highly dependent on the extension of the epileptogenic lesion and the patients' years of education. We therefore recommend not to use the same paradigm for all patients, but to adapt the selection of adequate test materials to their cognitive abilities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

In Ethiopia, the epilepsy knowledge gap among healthcare workers remains high. In this study, we conducted a survey among health care workers in Addis Ababa, Ethiopia, exploring their knowledge, attitudes, beliefs, and perceptions about social inclusion and exclusion regarding epilepsy. Furthermore, we analysed if and how these factors influence the management and quality of care provided. During a training workshop, 50 participants completed the survey. Nurses made up 22% of the participants, midwives comprised 11%, health officers constituted 16%, and medical officers represented 4%. Of the respondents, 69% were male, and 59% had experience in treating patients with epilepsy. This study showed that while 51% of respondents correctly identified epilepsy as being diagnosed after two seizures, many were uncertain about the criteria. Although 90% believed epilepsy is treatable, some were unsure or held misconceptions. Regarding its contagiousness, 82% correctly stated it is not contagious, but some held incorrect beliefs. Treatment options varied, with most recognizing clinical medicines, but some still believed in alternative methods like spiritual or herbal healing. Additionally, understanding of person-centered care was lacking, with several respondents admitting they were unfamiliar with the concept. The factors contributing to the epilepsy treatment gap in Ethiopia were a lack of comprehensive knowledge among healthcare workers about epilepsy, misconceptions such as the belief that epilepsy is contagious, inadequate management practices, challenges in accessing and securing medications due to shortages, and limited community awareness about the condition. Additionally, the study exposed a concerning gap in understanding of person-centered care among some healthcare workers. This study underscores the urgent need for targeted training programs, healthcare policies, and community awareness initiatives to enhance the quality of care for individuals with epilepsy in Ethiopia and similar settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Observational studies have consistently indicated a significant correlation between abnormal cardiac conditions and epilepsy. However, the association and direction of this relationship remain a subject of debate. This study employs a two-sample bidirectional Mendelian randomization (MR) approach to investigate the association between abnormal cardiac conditions and epilepsy., Methods: Instrumental variables, represented by single nucleotide polymorphisms (SNPs) associated with epilepsy and various abnormal cardiac conditions, were derived from large-scale genome-wide association studies databases, including FinnGen and UK Biobank. Bidirectional MR analysis was conducted to estimate the association between epilepsy and abnormal cardiac conditions. Sensitivity analyses were performed using MR-Egger, weighted median, Inverse Variance Weighted, and MR pleiotropy residual sum and outlier methods., Results: The forward MR analysis suggested a potential positive effect of atrial fibrillation and flutter (AF) and valvular heart diseases (VHD) on the risk of epilepsy. Conversely, the reverse MR analysis indicated that epilepsy might increase the susceptibility to AF, VHD, and heart failure., Conclusion: The findings support a bidirectional relationship between AF, VHD, and epilepsy, indicating that AF and VHD can elevate the risk of developing epilepsy, while epilepsy, in turn, can also increase the risk of developing AF and VHD. Furthermore, the study suggest that epilepsy may contribute to the development of heart failure. These results underscore the importance of screening for cardiac abnormalities in patients with epilepsy and vice versa, to better understand their clinical significance and potential as modifiable risk factors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Seizures are prevalent in glioma patients, especially in those with low-grade gliomas. The interaction between gliomas and epilepsy involves complex biological mechanisms that are not fully understood., Methods: We collected Genome-Wide Association Study data for epilepsy and gliomas, performed differential expression analysis, and conducted Gene Ontology (GO) enrichment analysis on the identified genes. Single-cell RNA sequencing data (scRNA-seq) from GSE221534 dataset in Gene Expression Omnibus (GEO) were used to analyze cell-cell interactions within glioma samples from patients with and without epilepsy., Results: Mendelian Randomization (MR) analysis revealed significant associations between genetic variants related to epilepsy and glioma risk, suggesting a potential causal relationship, especially in astrocytomas. Differential expression analysis identified epilepsy-related genes that were significantly upregulated in astrocytoma tissues compared to normal brain tissues. GO enrichment analysis indicated that these genes are involved in critical biological processes such as neurogenesis and cellular signaling. The scRNA-seq analysis showed, compared to non-epileptic samples, glioma stem cells, microglia, and NK cells are increased in the core regions of astrocytomas in epileptic patients. Additionally, intercellular communication between tumor cells and other non-tumor cells is markedly enhanced in astrocytoma samples from epileptic patients., Conclusion: This study provides evidence of a genetic association between epilepsy and gliomas and elucidates the biological mechanisms through which epilepsy may influence glioma progression., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: Health-seeking behaviors of individuals who have epilepsy might affect the treatment of the disease, recovery process, and self-care activities. The present study was conducted to determine the health-seeking behaviors of individuals who have epilepsy., Materials and Methods: The present study was conducted in a descriptive and cross-sectional design with 190 epilepsy patients who applied to the Neurology Clinic in the north and east of Turkey between April 2023 and January 2024. The data of the study were collected by using the Introductory Data Form, Health-Seeking Behavior Scale (HSBS). The IBM SPSS 27 software, variance analysis, Tamhane T2, ANOVA Test, Tukey Test, and Multiple Regression Analysis were used to evaluate the study data., Results: The mean score of the online health-seeking behavior sub-dimension of the Health-Seeking Behavior Scale of the individuals who had epilepsy was found to be 13.32 ± 5.40, the mean score of the professional health-seeking behavior sub-dimension was 9.92 ± 2.75, and the mean score of the traditional health-seeking behavior sub-dimension was 8.46 ± 3.29. No significant differences were detected between individuals' sex, seizure types, and health-seeking behaviors, and a significant difference was detected between marital status, educational status, place of residence, occupation, income level, seizure frequency, and medication use status and health-seeking behaviors (p < 0.05). According to the multiple linear regression analysis that was used to examine the effects of sociodemographic characteristics of individuals with epilepsy on health seeking behavior scale scores, it was found that sociodemographic characteristics such as educational status, place of residence, marital status, and age significantly affected online, professional, and traditional health seeking behavior scores., Conclusion: In conclusion, it was found in the present study that the online health-seeking behavior of the individuals who had epilepsy was higher than other health-seeking behaviors. The health-seeking behaviors of patients were affected by sociodemographic characteristics (e.g., marital status, educational status, place of residence, occupation, income level, seizure frequency, and medication use). It is of great importance to conduct larger future studies on individuals who have epilepsy and are seeking traditional treatment for epileptic seizures because the sources from which health information is obtained might affect the diagnosis, treatment, and recovery processes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Globally, 50 million people suffer from epilepsy, with more than 80% of patients with epilepsy living in low- and middle-income countries. The World Health Organization (WHO) estimates that approximately 25 million people in Africa have epilepsy. In Sub-Saharan Africa, 50 % of patients with epilepsy experience seizure-related physical injuries, including burns, fractures, motor vehicle accidents, dental injury, soft-tissue injuries, and submersion accidents., Objective: This systematic review and meta-analysis was conducted to assess the prevalence and associated factors of physical injuries among patients with epilepsy in Sub-Sharan Africa., Methods: A systematic review and meta-analysis were conducted between January 2012 and December 2023. An experienced librarian performed a thorough search across several databases, including PubMed, Medline, the Cochrane Database of Systematic Reviews, Up To Date, EMBASE, and NICE (National Institute for Health and Care Excellence). The search also included grey literature and unpublished studies. Data were extracted on the prevalence of physical injuries and associated factors among patients with epilepsy in Sub-Saharan Africa. A pooled analysis of prevalence was conducted using a random-effects model, and a systematic review of risk factors for physical injuries was performed., Results: A total of seven studies (n = 1724) were included. The pooled prevalence physical of injuries among patients with epilepsy in Sub-Sharan Africa is found to be 63.68 % (95 % CI: 62.15, 65.22; I2 = 99.7 %; p < 0.0001). Subgroup analyses were conducted by grouping the studies by country. We also employed a leave-one-out sensitivity analysis to identify potential sources of heterogeneity. Publication bias was assessed by visual inspection of meta-funnel plot and egger, begs test, and revealed there was no publication bias., Conclusion: This systematic review and meta-analysis can be used for policy maker, stakeholders and concerned body to set strategies to prevent seizure-related physical injuries among patients with epilepsy. The finding also allows clinicians to provide appropriate patient care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Having children or planning to have children may raise many questions for women with epilepsy. Seizures and antiseizure medications (ASMs) impact contraception, fetal/early childhood development, and maternal health. Little is known regarding patients' perspectives about reproductive risk and how those perspectives influence reproductive decision-making., Methods: As a quality improvement initiative, we distributed an electronic survey within our health system to women ages 21-45 with a primary diagnosis of epilepsy/seizures. We then performed an exploratory research study to investigate perceptions of risk of epilepsy and ASMs on reproductive health and decision making. Additionally, we looked at clinical characteristics as possible predictors of fear impacting reproductive decisions., Results: There were 267 responses (32% responder rate); after exclusion criteria, 233 respondents were included in the study. There were mixed responses about how fear of ASM teratogenicity impacted decisions about having children (33% very much, 34% a little, 33% not at all). While 45% responded that fear of having a child with epilepsy/seizures did not at all affect decisions about having children, for 24% this very much affected their decision. In total 42% of respondents reported they had had children. When we evaluated the impact of certain clinical characteristics, we found ASM number and valproic acid use impacted reproductive decision making, while other expected characteristics (e.g., drug-refractoriness and convulsive seizures) did not., Discussion: We found variation in perceptions of risk. Overall, our data support the very personalized nature of preferences and the need for individualized counseling when guiding patients in reproductive decision making., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Non adherence to antiseizure medications (ASM) is a common and modifiable risk factor for poor control of epilepsy and contributes to increased hospitalizations, bias in assessing the effectiveness of therapy and inaccurate clinical decision making.The aim of the study was to estimate proportion of nonadherence to antiseizure medications among children with epilepsy and to identify clinical and demographic factors that contribute to antiseizure medication non adherence., Methods: Consecutive subjects ≤ 18 years with epilepsy, on antiseizure medications for atleast three months, attending Pediatric Neurology OPD, Government Medical College Thiruvananthapuram, Kerala, India were included in the study. Self reported adherence to antiseizure medications was measured using Medication Adherence Report Scale questionnaire. Perceptions towards medications were assessed using Beliefs about Medicines Questionnaire Clinicodemographic factors and medication beliefs were analysed to examine their association with non-adherence in the participating children., Results: The rate of non-adherence in children with epilepsy was 32%. 68% of the study population had high necessity beliefs and 60% showed low concern beliefs, which indicated overall positive perception towards medications. Univariate analysis showed that the following were significantly associated with ASM non adherence: ASM side effects (OR:3.01; 95% CI:1.52-5.92; p < 0.001) and ASM Concerns (OR: 0.84; 95% CI: 0.77-0.92; p 0.0003) and Necessity-Concern Differential Score (OR: 1.19; 95% CI: 1.10-1.29; p 0.0001). Other clinic-demographic variables did not exhibit a significant association with adherence. Multivariate analysis showed that both ASM side effects and ASM beliefs, represented by NCD score remained significant., Conclusion: Perceptions towards medications have an important and potentially modifiable association with medication non adherence. Interventions to improve adherence should be tailored to each patient, including measures to address the specific beliefs of the patient and the family, along with practical barriers such as side effects of medications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

According to the common-sense model of self-regulation, illness representations influence treatment adherence and, thus, health status. As pediatric epilepsy management is usually shared between children/adolescents and parents, we aimed to assess and compare illness representations of both groups. Additionally, the role of gender and clinical variables in pediatric epilepsy representations was explored. One hundred and seventy-three dyads of Portuguese children/adolescents with epilepsy and parents were assessed with the Brief Illness Perception Questionnaire. Pediatric epilepsy was perceived as a moderate threat. Although epilepsy symptoms and consequences were mainly perceived as low, the emotional impact of the illness was moderate to high. Compared to children/adolescents, parents presented higher understanding of epilepsy, higher concern, and more intense emotional responses to the illness. Adolescents understood the illness better than children. Gender did not relate to illness representations among children/adolescents or parents. Epilepsy severity and control were the clinical variables most strongly associated with illness representations. Pediatric epilepsy representations should be routinely assessed separately for children/adolescents and parents, particularly following changes in epilepsy severity. When pediatric illness representations are found to be incongruent with medical information, such beliefs should be challenged, preferably with a tailored approach., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Epilepsy during childhood can have a highly important effect on the family system. Parents of epileptic children may experience stress, anxiety, and depression. Adherence to treatment has been reported to be suboptimal among children with epilepsy., Method: In this descriptive, correlational study, the convinience sampling method was used to select 100 caregivers of children with epilepsy, referring to the neurological department and clinic. The required data were collected using the Pediatric Epilepsy Medication Self-Management Questionnaire (PEMSQ) to evaluate parents' medication self-management, one of which is adherence to treatment. In addition, the Depression Anxiety and Stress Scale (DASS-21) was utilized to assess the levels of stress, anxiety, and depression in parents., Result: Based on the results, the mean scores (SD) of depression, anxiety, and stress were 33 (9), 27 (10), and 26 (9), respectively. The total score for medication self-management was 111.72 ± 13.5. Among the four fields of PEMSQ, knowledge and expectations from the patient had the lowest score, while treatment barriers represented the highest score. there was a statistically significant, mild correlation between parental stress level and parental disease knowledge and expectations., Conclusion: The findings of the current study revealed that most caregivers had high levels of stress, anxiety, and depression. there is a statistically significant but mostly weak relationship between parents' stress, anxiety, and depression and disease knowledge and expectations, medication adherence, beliefs about medication efficacy, barriers to treatment, and overall medication self-management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Epilepsy and multiple sclerosis (MS) are both chronic neurological diseases with a high symptom burden, including depression and resulting in lower health-related quality of life (HRQoL). Peer-support groups seem to be beneficial to improve HRQoL and depression. Since the course of the two diseases varies, the question arises if they differ in terms of HRQoL, depression and coping strategies and which predictors are related to HRQoL in peer-supported people., Methods: A total of 90 participants with epilepsy (n = 46) or MS (n = 44), recruited from local or online peer-support groups, were surveyed by questionnaire. HRQoL (SF-36), coping with illness (FKV-LIS), depression (BDI-II), socio-demographic and clinical data were examined., Results: The two peer-supported groups did not differ, neither in coping strategies nor in HRQoL, with the exception of the physical related scales. However, the HRQoL values in both groups were worse than in general population. An important predictor of HRQoL in epilepsy as well as in MS was depression, which was present in 40 % of cases., Conclusions: Even people with MS or epilepsy who attended a peer-support group, i.e. who have been actively coping with their disease, had a reduced HRQoL. Neither coping strategies nor other disease related variables but comorbid depression was the most significant predictor of poorer HRQoL. Our results support the necessity to treat comorbid depression and thereby improve HRQoL, even in peer-supported people., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

This manuscript provides practical insights, tips, and lessons particularly valuable for early-career healthcare professionals new to using ketogenic diet therapy (KDT) in clinical practice. The review aims to be accessible, emphasizing actionable knowledge that can be directly applied in a clinical setting. The KDT for epilepsy includes not only the classic KDT but also the modified Atkins diet, the medium-chain triglyceride ketogenic diet, and the low glycemic index treatment. This highly effective non-pharmacological treatment can be rapidly implemented for patients with drug-resistant epilepsy. Identifying suitable candidates and conferring criteria for selecting patients who are likely to benefit ('good responder') from the ketogenic diet is critical for earlier intervention minimizing the burden of seizures and long-term polytherapy. On the other hand, this article outlines conditions where the ketogenic diet may not be appropriate, such as in patients with specific metabolic disorders, representing contraindications or cautions where there are concerns about adherence. Finally, the use of KDT in special settings (e.g., ICU) and how to deal with the most common side effects and abnormal laboratory results are provided based on an updated review and the experience from three level three epilepsy centers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Increasing evidence suggests that activated innate/adaptive immunity induces an inflammatory response, thereby participating in epileptogenesis. However, the biological explanation of inflammation/immunity as a potential cause for epilepsy remains largely unknown. This research aimed to determine the causal effects of inflammation/immune-related genes in epilepsy based on multi-omics mendelian randomization (MR)., Methods: We employed summary-data-based MR (SMR) approach to combine GWAS for epilepsy (12,891 cases and 312,803 control) with gene expression quantitative trait loci (cis-eQTL, 31,684 participants) and DNA methylation QTL (cis-mQTL, 1,980 participants) data. Five additional MR methods were then used for sensitivity analyses to confirm the reliability of causal associations. In addition, enrichment analysis of key genes was conducted to provide insight into the biological functions of epilepsy risk variants., Results: A total of 386 inflammation/immune-related genes were selected for further analyses. Primary SMR analysis indicated that 37 DNA methylation sites and six genes regulated by them had potential causal relationship with epilepsy. MR analysis further refined the results, identifying three genes that had a causal effect on epilepsy. Notably, VEGFA (OR: 0.925; 95 % CI: 0.862-0.994) expression was negatively correlated with epilepsy risk, whereas IL16 (OR: 1.076; 95 % CI: 1.028-1.126) and HLA-DPA1 (OR: 1.041; 95 % CI: 1.009-1.074) expressions were positively associated with epilepsy risk. Functional enrichment analysis revealed that the identified genes were involved in GO-BP terms related to VEGF activation signaling and chemotaxis regulation., Conclusion: This analysis confirms the causal role of inflammation/immunity in epilepsy, and the identified candidate genes provide clues for drug development in clinical practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Rationale: Young people with epilepsy of childbearing potential (YPWECP) are vulnerable to a variety of adverse health outcomes due to teratogenic antiseizure medications (ASMs) and drug-drug interactions between ASMs and contraceptives that can lead to breakthrough seizures and/or contraceptive failure. To better understand reproductive healthcare provision for YPWECP, we conducted a retrospective analysis of relevant prescription patterns., Methods: We analyzed procedural and medication data for YPWECP ages 13-21 years (n = 1525) from 2011 through 2021 at a single tertiary-care pediatric medical center to investigate rates of (1) prescription of folic acid, (2) prescription of an enzyme-inducing ASM<6 months before or after hormonal contraception initiation (or < 3 years after subdermal implant placement), (3) prescription of lamotrigine < 6 months before or after an estrogen-containing contraceptive that could affect lamotrigine serum concentrations, and (4) documentation of any contraceptive medication or device that overlaps initiation of a patient's first teratogenic ASM. We performed statistical analyses with sample proportion z-tests. We then used logistic regression and generalized estimating equations to evaluate for associations between patient characteristics and prescription patterns., Results: Among 1525 YPWECP, less than half (41 %, n = 629) were prescribed folic acid during the study period (95 % CI 38.8-43.7). Of YPWECP prescribed an enzyme-inducing ASM, 24 % (186/766) were co-prescribed a hormonal contraceptive that adversely interacts with the ASM (95 % CI 21.2-27.3 %). Of those prescribed lamotrigine during the study period, 24 % (111/472) had documentation of an estrogen-containing medication that could affect lamotrigine serum concentrations < 6 months before or after that prescription (95 % CI 19.7-27.3 %). Of those prescribed a teratogenic ASM, only 13 % (82/638) had documentation of contraception prior to (or within the same month as) starting their first teratogenic ASM (95 % CI 10.3-15.5 %). Older age was associated with increased odds of contraceptive coverage prior to initiation of the first teratogenic ASM and was also associated with increased odds of having contraceptives co-prescribed with ASMs that could interact. No significant associations were found between race/ethnicity and any outcomes., Conclusions: YPWECP experience low rates of folic acid prescription and low rates of contraceptive coverage while prescribed teratogenic ASMs. Many YPWECP, particularly older adolescents, are at increased risk for contraceptive failure and/or breakthrough seizures due to drug-drug interactions. Results demonstrate a need for increased focus on reproductive healthcare for YPWECP. Future studies should evaluate interventions aimed at improving these outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study aimed to investigate whether folic acid supplementation at normal or high doses could reduce major congenital malformations and improve neurodevelopment in the offspring of women with epilepsy (WWE)., Methods: The MEDLINE, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov databases were searched for observational studies reporting pregnancy outcomes and information about folic acid supplementation in WWE, with a cut-off date of December 5, 2023. Data extraction and synthesis were performed in accordance with the PRISMA guidelines. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted to obtain pooled odds ratios (ORs) and 95% confidence intervals (CI), to estimate the effect of periconceptional folic acid supplementation on pregnancy outcomes in WWE. Sensitivity analyses including only studies with WWE who took anti-seizure medications during pregnancy or studies with a sample size greater than 100 were further performed. This study was registered in PROSPEROID (no. CRD42019141820)., Results: The database search yielded 23 eligible articles. Unexpectedly, the results of subsequent meta-analysis showed that the risk of major congenital malformations was relatively higher in those with periconceptional folic acid supplementation (17463 pregnancies, OR, 1.34; 95 %CI, 1.12-1.6), and was similar between those with and without folic acid supplementation ≧ 4 mg (3822 pregnancies, OR, 0.9; 95 %CI, 0.65-1.24). Results showed that periconceptional folic acid supplementation may be beneficial for neurodevelopment but the evidence was limited., Conclusions: This systematic review showed no evidence of a beneficial effect of folic acid supplementation in reducing the risk of major congenital malformations, while the relative risk was slightly higher in those receiving periconceptional folic acid supplementation. Nevertheless, folic acid supplementation may improve neurobehavioral outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study evaluated the profile of language and reading skills among children with epilepsy. We utilized a sample of children from an epilepsy database who were administered a measure of reading comprehension, excluding those whose intellectual skills were in the impaired range (N=147; age range 4-20 years, 52 % female). Additional measures that were considered within the sample included broad language skills, pre-reading skills (phonological processing, rapid naming, decoding), and basic reading skills (sight word reading, reading fluency). We further considered associations between these skills and seizure characteristics (age of onset, number of anti-seizure medications, seizure type, seizure frequency, and localization). We found that our sample performed significantly lower on all language and reading skills, on average, than normative expectations. Within our sample, relative strengths were noted in broad language skills, and relative weaknesses were found in phonological processing, rapid naming, reading fluency, word reading, and reading comprehension. We further identified a subgroup of our sample (31 %) who were characterized as struggling in reading comprehension (performing one standard deviation below the normative mean); these children exhibited a profile more consistent with non-epilepsy samples with reading disabilities/ dyslexia. Seizure variables that were associated with language and reading skills included age of onset, number of anti-seizure medications, seizure frequency, and having generalized (versus focal) seizures. These results have important implications for the identification and treatment of reading problems in children with epilepsy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

A number of studies have been conducted on the effects of the COVID-19 pandemic on people with epilepsy (PWE), some showing increased seizures, poorer psychosocial states, and reductions in Quality of Life (QoL). During the latter stages of COVID-19, well before the UN declared an end to the state of emergency, our study was conducted in Australia of a sample of women and men ≥ 18 years. The study was based on Wave 6 of the Australian Epilepsy Longitudinal Study (AELS). It used mixed methods. Two main scales were used in the study, the QOLIE-31 for QoL and the MOS-8 for social support. The quantitative component of the study looked at QoL in relation to COVID-19 and found no QoL differences in those who contracted the virus. However, there was significantly lower QoL in those having difficulties in seeing a GP, for those with limited access to healthcare, and for those who had problems in gaining ASMs (anti-seizure medicines) and/or other medicines and being unvaccinated. Being younger and living in rental accommodation were most likely significant contributing factors. Those not being vaccinated were less than the proportion in the whole national population., The qualitative component focussed on reasons for being vaccinated or not. Overall, the responses to the question "Were you vaccinated?" demonstrated that people made informed decisions on vaccinations, taking into account their own health as well as protecting family and public health considerations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The lifetime prevalence of epilepsy varies between 3.5 and 10.7 per 1000 individuals in developed countries, and from 0.9 to 74.4 per 1000 individuals in Asia, sub-Saharan Africa, and Latin America. In adolescents, the prevalence of epilepsy is estimated to be 1.5 to 2%., Purpose: The purpose of this study was to examine the clinical characteristics of adolescents with epilepsy (AWE) and highlight the differences between childhood-onset epilepsy and adolescent-onset epilepsy. Additionally, the study aimed to assess the level of self-stigma and depression, as well as their impact on adherence to antiseizure medication (ASMs)., Methods: This cross-sectional study was conducted at the Epilepsy Clinic at Kasr Al-Ainy Hospitals. Patients underwent a thorough evaluation of their seizure history, as well as completed the Adherence to Refills and Medications Scale (ARMS), Kilifi Stigma Scale for Epilepsy (KSSE), and Patient Health Questionnaire-9 (PHQ-9) to assess depression., Results: A total of 136 AWE were included in the study, consisting of 82 males and 54 females with a median age of 15 and an interquartile range of 13-17. Most patients (54 %) had focal onset seizures, while the remaining 46 % had generalized onset seizures. Of the total sample, 87 (64 %) achieved seizure control for at least one year and are currently taking ASMs. However, only 60 % of the patients were found to be adherent to their ASMs. Fourteen patients (17.2 %) met the criteria for drug-resistant epilepsy. Interestingly, patients with adolescent-onset epilepsy were significantly more adherent to their ASMs compared to those with childhood-onset epilepsy (P=0.01). Additionally, the adherent group had significantly lower scores on KSSE and PHQ-9 compared to the non-adherent group (P=<0.0001 for each). Furthermore, there was a positive correlation between scores on the KSSE and PHQ-9 (P<0.001)., Conclusion: Depression and self-stigma are significant barriers to adherence among adolescents with epilepsy. These findings highlight the need to involve psychiatrists and epileptologists in epilepsy transition programs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To systematically assess the risk factors for secondary epilepsy in children with febrile seizures, in order to promptly identify early signs of epilepsy and establish a reliable foundation for timely clinical intervention and improved prognosis., Methods: The databases, including CNKI, WanFang, VIP, CBM, PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies, up to October 2023. Two researchers independently collected and extracted data from selected studies, adhering to predefined criteria. Statistical analysis was performed using Stata 15.0., Results: A total of 23 studies included 714 cases in the case group and 5269 cases in the control group. The results of Meta-analysis showed that preterm birth (OR=3.30, P=0.02), history of perinatal asphyxia (OR=3.94, P=0.001), age at the first seizure < 12 months (OR=2.93, P=0.003), peak temperature < 39℃ (OR=2.51, P<0.001), onset of fever to seizure < 1 h (OR=5.61, P<0.001), Complex FS(OR=4.08, P<0.001), duration of the seizure > 15 min (OR=6.21, P<0.001), Multiple seizures (≥2/episode) in one attack (OR=2.92, P<0.001), focal seizures (OR=2.53, P=0.018), recurrent FS (≥2) (OR=3.49, P<0.001), neurodevelopmental abnormality(OR=8.68, P<0.001), developmental delay(OR=10.04, P<0.001), family history of epilepsy (OR=2.74, P=0.004), family history of FS (OR=2.07, P=0.022), electroencephalogram (EEG) abnormal(OR=4.06, P<0.001)and Brain imaging abnormalities (OR=2.84, P=0.002)were Risk factors for secondary epilepsy following FS in Children. Notably, gender (female) was not a significant factor., Conclusions: This study provides a comprehensive and systematic discussion of the risk factors associated with secondary epilepsy in children with febrile seizures. It actively formulates intervention measures for modifiable risk factors and conducts early detection and continuous follow-up observation for non-modifiable high-risk children, thereby reducing the risk of epilepsy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Epilepsy fundamentally involves a struggle with "control," commonly framed in terms of reducing the frequency and severity of seizures. This paper seeks to understand how people with epilepsy (PWE) think about and define control, as well as the psychosocial outcomes of self-managing epilepsy and low perceived control. Here, we employ a qualitative analysis of interviews with 64 adults with epilepsy in treatment in a tertiary referral center in New York City, conducted between July 2020 and July 2022 as part of a larger study of the lived experiences of PWE. The interviews were coded, and thematic analysis was used to identify participants' constructions of control and the breadth of illness intrusiveness they experienced. Findings indicate that applying the illness intrusiveness concept to epilepsy aligns with existing research, revealing that PWE are impacted in numerous ways beyond seizure frequency and severity. Participants reported significant anxiety related to the unpredictability of seizures and the potential embarrassment of having seizures in public. These insights highlight that illness self-management and social challenges are critical components of the experience of having epilepsy. Our findings underscore the need for a wholistic approach to improving quality of life for PWE that recognizes the broader context of illness intrusiveness. By understanding and enhancing perceived control, future interventions can better support the mental health and overall well-being of PWE., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Epilepsy is a disease that commonly manifests in childhood and can significantly affect the quality of life for both sufferers and their families. As such, it necessitates comprehensive and high-quality healthcare., Objective: To assess the impact of an educational intervention targeted to caregivers of children and adolescents with epilepsy., Materials and Methods: A cross-sectional study conducted between February and November 2022, involving 140 patients and their primary caregivers who intentionally sought medical consultation at a pediatric hospital in Caldas, Colombia. Initial nursing consultations were conducted to identify clinical and demographic characteristics and to assess knowledge about the disease, its management, and care. Subsequently, a comprehensive educational process was implemented using various educational aids. After 60 days, feedback was provided to evaluate the caregivers' learning., Results: Focal epilepsy, generalized epilepsy and idiopathic focal epilepsy predominated in the medical diagnoses. The etiology highlighted genetic cause and structural 70% of caregivers were female. Caregivers' schooling: 10% of caregivers did not have schooling, 28% had primary education, 46% had secondary education, 16% had postgraduate education. Caregivers demonstrated knowledge about epilepsy and its management, with the majority scoring above 50%. The posttest indicated improvement in learning processes, and caregivers expressed that it benefited them in learning first aid., Conclusion: Establishing educational programs tailored to the needs of individuals and promoting care plans are essential for improving the living conditions of patients with epilepsy and their caregivers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: As epilepsy management medical devices emerge as potential technological solutions for prediction and prevention of sudden death in epilepsy (SUDEP), there is a gap in understanding the features and priorities that should be included in the design of these devices. This study aims to bridge the gap between current technology and emerging needs by leveraging insights from persons with epilepsy (PWE) and caregivers (CG) on current epilepsy management devices and understanding how SUDEP awareness influences preferences and design considerations for potential future solutions., Methods: Two cross-sectional surveys were designed to survey PWE and CG on medical device design features, SUDEP awareness, and participation in medical device research. Data analysis included both qualitative thematic analysis and quantitative statistical analysis., Results: The survey revealed that among 284 responses, CG were more aware of SUDEP than PWE. Comfort was identified as the primary concern regarding wearable medical devices for epilepsy management with significant differences between PWE and CG regarding acceptance and continuous use preferences. The thematic analysis identified integration with daily life, aesthetic and emotional resonance, adaptability to seizure characteristics, and user-centric design specifications as crucial factors to be considered for enhanced medical device adoption. The integration of a companion app is seen as an important tool to enhance communication and data sharing., Discussion: This study reveals that while SUDEP awareness can promote the development of future SUDEP predictive and preventive medical devices, these should be designed to mitigate its impact on daily life and anxiety of both PWE and CG. Comfort and acceptance are seen as key priorities to support continuous use and are seen as a technical requirement of future medical devices for SUDEP prediction and prevention. Widespread adoption requires these technologies to be customizable to adapt to different lifestyles and social situations. A holistic approach should be used in the design of future medical devices to capture several dimensions of PWE and CG epilepsy management journey and uphold communication between healthcare professionals, PWE and CG., Conclusion: Data from this study highlight the importance of considering user preferences and experiences in the design of epilepsy management medical devices with potential applicability for SUDEP prediction and prevention. By employing user-centered design methods this research provides valuable insights to inform the development of future SUDEP prediction and prevention devices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objective: It is seen that religious coping methods are used in the literature, but the existing literature on religious coping methods and coping strategies used by epilepsy patients is insufficient. Therefore, this study aimed to determine the positive and negative religious coping levels of epilepsy patients., Methods: This research is a descriptive research type. The research data were collected from patients with epilepsy living in a province in eastern Turkey between April and June 2024. The research population consists of epilepsy patients living in Erzurum province. The sample consisted of 154 patients who agreed to participate in the study. Data collection tools were "Questionnaire Form" and "Religious Coping Scale." Frequency, percentage calculations, mean and standard deviation values were used to evaluate the data. One Way Anova, Independent Sample t-test, Mann-Whitney U, and Pearson correlation tests were also used., Results: Positive religious coping scores (22.90 ± 5.35) and Negative religious coping scores (7.24 ± 3.25) of epilepsy patients were found to be at high levels. Participants' gender, marital status, occupation, income status, prayer, fasting, and Quran reading habits significantly affected their positive religious coping behaviors (p < 0.05). In addition, it was determined that as the age of the participants increased, they resorted to positive religious coping behaviors more (r: 0.215, p < 0.05)., Conclusions: The results of the study show that the positive and negative religious coping levels of epilepsy patients are high. In addition, the participants prefer positive religious coping behaviors more., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Mental health symptoms are common in people with epilepsy, impacting medication adherence, quality of life, and mortality. Early detection and timely interventions for mental health symptoms will be crucial for improved outcomes but the absence of standardized screening procedures and time constraints hinder regular assessment and management., Purpose: To evaluate feasibility, acceptability and, value of a digital tool for identifying mental health symptoms in adult and paediatric epilepsy outpatients using electronic Patient-Reported Outcome Measures (ePROMs)., Methods and Materials: The study used an established local platform (IMPARTS - Integrating Mental and Physical Healthcare: Research Training and Services) to develop an online tool using e-PROMS for a comprehensive mental health screen (psychiatric symptoms, neurodevelopmental traits, and psychosocial/behavioural risk factors) of people with epilepsy. Prior to attending the outpatient clinical epilepsy services at King's College Hospital, participants were invited to complete the online screening tool through an SMS appointment link., Results: Out of 1081 epilepsy patients (955 adults, 126 paediatric), 38.2% of adults and 51.6% of carers of paediatric patients accessed the ePROMs, with modest completion rates of 15% and 14%, respectively. Adults reported mild to significant anxiety (37.4%), minor to major depression symptoms (29.2%), and occasionally psychotic symptoms (11.1%). Adults with self-reported psychiatric symptoms reported significantly higher number of seizures, seizure burden, insomnia, autistic and ADHD traits and lower quality of life and perceived social support. Only 21% of those reporting psychiatric symptoms were receiving any form of mental health support. A large proportion of paediatric patients presented emotional/behavioural difficulties (32%), high impulsivity (38.8%), low self-esteem (27.7%), sleep difficulties (50%), comorbid neurodevelopmental syndromes (27.7%). Both groups reported good level of perceived social support., Conclusion: Our epilepsy adapted IMPARTS e-PROMS allowed remote screening for mental health symptoms, neurodevelopmental and resilience factors. Integrating these tools into electronic patient records might enhance early identification and facilitate referral to appropriate care pathways., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Transition from the paediatric holistic approach to the adult more individual care of epilepsy is a process that carries a high level of complexity and involves many actors. It is a mandatory step so to provide a gold-standard quality of care in young people with epilepsy. Its failure is strongly associated with a poor epilepsy, cognitive, and behavioural outcome. Although the interest of the scientific community on transition has increased, in the clinical practice it is still considered a sensitive issue, in particular for adult neurologists. In this study we aimed at exploring pitfalls and unmet needs of transition from the adult neurologists' perspective. A short survey, aimed to adult neurologists, was designed to explore i) whether transition is considered a problematic issue for the adult neurologist, ii) how transition impact his/her clinical practice, iii) which are the major problems related to the process, and iv) how transition may be improved. The results of the survey showed that transition is felt as a complex process that needs a shared action plan between child and adult neurologists, possibly with multidisciplinary team meetings as well as a higher training on childhood epilepsies for the adult neurologist., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Of all patients with brain tumors, about 30-50% suffer from epileptic seizures. The probability of developing epilepsy is particularly high in low-grade, epilepsy-associated brain tumors (LEAT). LEATs often show a pronounced network dysfunction with extensive EEG pathologies and cognitive deficits, and the epilepsies are often difficult to treat. In high-grade brain tumors, epileptic seizures determine morbidity and quality of life. The underlying mechanisms of epileptogenesis of brain tumors are increasingly understood and raise hope for personalized therapeutic approaches. This short, focused review provides an overview of the current understanding of brain tumor-related epilepsies. This paper was presented at 16th International Epilepsy Course and Colloquium held in Frankfurt a.M., Germany, September 2024., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CM reports speakers’ honoraria and travel support from UCB, outside of the submitted work. N. M. has received honoraria for lecturing and travel expenses for attending meetings from Biogen Idec, GlaxoSmith Kline, Teva, Novartis Pharma, Bayer Healthcare, Genzyme, Alexion Pharmaceuticals, Fresenius Medical Care, Diamed, UCB Pharma, AngeliniPharma, BIAL and Sanofi-Aventis, has received royalties for consulting from UCB Pharma, Alexion Pharmaceuticals and Sanofi-Aventis and has received financial research support from Euroimmun, Fresenius Medical Care, Diamed, Alexion Pharmaceuticals, and Novartis Pharma. DM has nothing to declare., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The prescription of levetiracetam during pregnancy has become more common due to its lower teratogenic risk profile. However, due to a lack of data about its association with stillbirth and spontaneous abortion, worries remain., Objective: To investigate information on any possible association of spontaneous abortion and stillbirth adverse events with levetiracetam in women with epilepsy., Methods: This retrospective pharmacovigilance study used disproportionality analysis to detect signals of adverse reaction of interest reported with Levetiracetam in FAERS, the FDA Adverse Event Reporting System. The ratio of reporting odds (ROR) and information component (IC) indices were used to undertake disproportionality analyses, and change point analyses were carried out to identify variations in the frequency of reporting of relevant adverse events. Sensitivity analyses included subgroup analyses by indication, treatment regimen, and reporting region., Results: Overall, 2870 cases of spontaneous abortion and stillbirth with commonly used antiseizure medications were analyzed. A total of 65.5 % of these cases had epilepsy as the indication. In the entire dataset, we observed disproportionality signals of spontaneous abortion for 6 ASMs (levetiracetam, carbamazepine, lamotrigine, oxcarbazepine, topiramate, valproic acid) and disproportionality signals of stillbirth for 4 ASMs (levetiracetam, carbamazepine, lamotrigine, oxcarbazepine). In the epileptic population, disproportionality signals for stillbirth (ROR 0.25  = 4.60; IC 0.25  = 1.30) and spontaneous abortion (ROR 0.25  = 3.98; IC 0.25  = 1.20) in levetiracetam was identified. These disproportionality signals have been consistently robust over the past years, according to a temporal assessment of them. Sensitivity studies proved how reliable the findings were., Conclusion: Using validated pharmacovigilance methods, we found significant disproportional signals for spontaneous abortion and stillbirth associated with levetiracetam. Of these, the signals for spontaneous abortion were observed after 2011 and for stillbirth after 2014, which may be related to the rise in levetiracetam prescriptions during pregnancy in recent years. The association of spontaneous abortion and stillbirth adverse events with levetiracetam and potential biases confounding this association merit further investigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)